Provider Demographics
NPI:1609023530
Name:SAINT JOSEPH FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:SAINT JOSEPH FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SCHADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-983-4500
Mailing Address - Street 1:2330 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2606
Mailing Address - Country:US
Mailing Address - Phone:269-983-4500
Mailing Address - Fax:269-983-4509
Practice Address - Street 1:2330 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2606
Practice Address - Country:US
Practice Address - Phone:269-983-4500
Practice Address - Fax:269-983-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty